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논문KCI 등재

진행성 유방암의 맞춤 항암요법의 최신 지견

Personalized therapy for advanced breast cancer using molecular signatures

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참고문헌

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초록

유방암은 우리나라 여성에서 두 번째로 흔히 발생하는 암으로 근치적 치료 후 많은 환자에서 재발한다. 전이성 유방암은 비교적 항암요법에 반응이 좋고 중앙 생존기간도 약 2~3년으로 길지만 완치는 어렵다. 현재 임상에서 사용되는 전이성 유방암의 치료에는 호르몬치료, 항HER2 요법 및 항암화학요법이 있는데, 재발한 환자의 임상적 상태와 암의 특성에 따라 각 치료방법에 대한 반응을 예측하고 치료법의 독성을 고려함으로써, 치료의 부작용은 최소화하면서 생존기간을 향상시키고 삶의 질을 향상시킬 수 있다. 호르몬 수용체와 HER2 과발현 여부는 치료에 대한 반응 예측에 가장 중요한 인자로 원발성 유방암은 물론 전이암에서 다시 검사하는 것이 추천된다. 호르몬치료는 부작용이 적어 호르몬 수용체 양성인 환자에서 일차치료로 추천된다. 그간 tamoxifen이 호르몬치료의 근간을 이루었으나, 최근 폐경 후 여성에서 3세대 아로마타제 억제제의 우수성이 입증되면서 더 선호되고 있다. 호르몬치료에 반응한 환자는 다음 호르몬치료에 반응할 확률이 높으며 호르몬치료에 반응하지 않는 환자, 호르몬 수용체 음성인 환자와 급격히 진행하는 전이성 유방암에서는 항암화학요법이 추천된다. Trastuzumab은 전이성 HER2 양성 환자의 일차 치료제로 항암제와 병용하는 것이 표준치료이며, lapatinib은 trastuzumab 치료에 실패한 환자에서 효과가 입증되어 사용되고 있다.

Abstract

In Korea, breast cancer is the second common cancer in women and many patients suffer from metastatic disease after surgery and adjuvant therapy. Metastatic breast cancer is unlikely to be cured, but it is possible to choose therapeutic options according to clinical factors and tumor biology to avoid unnecessary toxicity and improve efficacy. Hormone receptors and HER2 status are the most important predictive factors and should be evaluated in all breast cancers. Hormonal treatment is preferred for initial treatment of hormone receptor positive metastatic breast cancer due to its more favorable side effect profile. Tamoxifen has been the mainstay of hormonal treatment. However, new aromatase inhibitors challenge tamoxifen as the first line therapy in postmenopausal women. Trastuzumab with conventional chemotherapy is the standard of care in patients with strong overexpression of HER2 and lapatinib is active after trastuzumab failure.

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